Bibliografisk note

Funding Information:
This study was supported by a grant from The Oticon Foundation (Smørum, Denmark) (grant number 15-1293 ) to University Hospital Rigshospitalet, Copenhagen, Denmark . The Otopod M2 was provided by Widex, (Lynge, Denmark). No funding bodies were involved in designing the study, collection, analysis or interpretation of data, nor in the writing or publication of the report.

Funding Information:
Only 0.4% (two children) suffered from SNHL, which is lower than findings in comparable studies, in which prevalences of 1?3% are typically reported [10,19,30]. Besides the statistical uncertainties that arise with a small sample size like in the present study, a possible explanation of the low prevalence of SNHL is the relatively high immunisation coverage in Zimbabwe. Vaccination against measles, a common cause of SNHL, is publicly available in Zimbabwe, and hence immunisation coverage is high (92% according to official statistics) [31]. The MR vaccine (mumps-rubella) was not introduced in Zimbabwe until late 2015, and therefore our study population is likely not protected. Official figures state that in 2013, 92% of Zimbabwean children had received the pneumococcal vaccine introduced the previous year [31], so a majority of the children in our cohort are likely protected against streptococcus pneumonia. As this bacterium is a common cause of OM in high-income countries, a significant decline in AOM has been demonstrated in the United States after introducing the heptavalent pneumococcal conjugate vaccine [32,33]. Nonetheless, recent studies from Africa found streptococcus pneumonia in <2% of OM cases [34,35], so the effect of the pneumococcal vaccine on paediatric HL in this setting is likely debateable. Furthermore, although schooling in Zimbabwe is provided publicly, schools typically charge a fee; in our study, 60?105 USD/year. In this setting with limited financial resources, one could speculate that since SNHL is generally more profound, parents/guardians might tend to keep affected children home. To truly assess the burden of SNHL in Mashonaland East, larger sample studies are needed, preferably community-based.This study was supported by a grant from The Oticon Foundation (Sm?rum, Denmark) (grant number 15-1293) to University Hospital Rigshospitalet, Copenhagen, Denmark. The Otopod M2 was provided by Widex, (Lynge, Denmark). No funding bodies were involved in designing the study, collection, analysis or interpretation of data, nor in the writing or publication of the report.

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